Act Now For Increased Medicaid Reimbursement

 

Primary care physicians in pediatric medicine, family medicine, internal medicine and related subspecialties recognized by the American Osteopathic Association, American Board of Medical Specialties, or American Board of Physician Specialties, are eligible to receive increased Medicaid payments for primary care services provided to Medicaid eligible individuals.

You MUST self-attest through MITS by January 19, 2013, to receive reimbursement retrospectively to January 1. After January 19, reimbursement will begin as of the date you attest online.

If you are not board-certified in one of these areas, you may still be eligible after a review of your billing determines that at least 60 percent of the Medicaid codes billed for calendar year 2012 were for Evaluation and Management and vaccine administration codes.

The federal government will fully finance the difference between the state Medicaid payment rate and the current year Medicare rate, January 1, 2013, through December 31, 2014. To register, applying physicians must have a current MITS account with an active login and PIN. Some answers to frequently asked questions are printed below. 

Who is eligible for increased reimbursements? Primary care physicians with the following specialty designations: pediatric medicine family medicine internal medicine subspecialists within the specialty designations listed above recognized by the American Board of Medical Specialties, the American Board of Physician Specialties, or the American Osteopathic Association. To qualify, the primary care physician who self-attests must either:

What if I’m not board-certified? You may still be eligible after a review of your billing determines that at least 60% of the Medicaid codes billed for Calendar Year 2012 were for Evaluation and Management (E/M) and vaccine administration codes.

What does it mean to have a “specialty designation” in one of the specialties or subspecialties listed above? You will be considered to have a “specialty designation” in one of the listed specialties or subspecialties if you are either board certified in that specialty, or if you practice that specialty within the community. For example, you may be board-certified in a non-eligible specialty such as surgery or dermatology, but practice within the community as a family practitioner. If your board certification is in a non-eligible specialty, you may be eligible for the primary care rate increase if a review of your claims history indicates that at least 60% of the Medicaid codes paid for Calendar Year 2012 or Calendar Year 2013 were for qualifying Evaluation and Management (E/M) and vaccine administration codes.

I am a family physician who is board certified by the American Board of Family Medicine (ABFM) but I do not have a certification number. The MITS online application asks for one. How do I attest that I am board certified? Physicians who are board certified by ABFM and do not have a board certification number can type “not applicable” in the board certification number field.

When will the rate increase be in effect? The ACA mandates that states pay the rate increase beginning January 1, 2013 through December 31, 2014.

When will I begin receiving the enhanced payments? Physicians who are approved by the Office of Medical Assistance (OMA) can expect to see increased payments beginning in April 2013 when OMA anticipates CMS will approve Ohio’s State Plan Amendment to implement the Primary Care Rate increase. Qualified physicians approved by OMA who contract with a Managed Care Plan (MCP) will receive the enhanced payment directly from the MCP. These payments may be made retrospectively.

 What do I have to do to apply to receive the enhanced payments? Physicians MUST REQUEST the reimbursement by self-attesting that they are an eligible provider by applying through the MITS portal on Ohio Medicaid’s website. In order to register, applying physicians MUST have a current MITS account with an active login and PIN. Providers can apply beginning on January 1, 2013.

  •  If additional assistance is needed regarding signing up for a MITS account, please call the Medicaid Provider Call Center at 1-800-686-1516.

 When will I know if I’m approved for the increase? Verification of attestation will begin in mid-January. You will then receive an email stating whether you have been approved or denied for the reimbursement increase. For physicians who self-attest on January 1, 2013 through January 19, 2013, the effective date for the reimbursement increase, if approved, will be January 1, 2013. For approved self-attestations submitted January 20, 2013 or later, the effective date of the reimbursement increase will be the date of self-attestation.

What if I contract with a Managed Care Plan – how do I apply and who will pay me? Providers must still apply to receive the enhanced payment through the MITS portal by self-attesting that they are an eligible primary care provider. Once OMA verifies that a provider is eligible, the Managed Care Plan (MCP) will receive notification of a provider’s eligibility and the effective date of eligibility. The MCP will pay the provider the enhanced payment directly.

Do primary care services delivered by non-physician practitioners incident to a physician service qualify for the enhanced payment? In order to ensure that eligible physicians receive the enhanced payment for these services, OMA will require that these services be billed under the supervising physician’s Medicaid enrollment number appended with the appropriate non-physician modifier. Services billed under the non-physician Medicaid enrollment number will not be eligible for the enhanced payment.


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